Would men use one?

Surveys show men want new contraceptive options.

For many decades, popular belief held that men were not interested in “taking responsibility” for their fertility—that once the Pill became available, men were no longer willing to share the burden of contraception within a relationship. Although this was certainly never true of all men, it may have been true of a significant percentage of men in previous decades. However, in recent decades, studies have begun to show a cultural and generational shift.

Now that baby boomers and post-baby boomers make up the majority of men needing contraception, 13% to 80% of men (depending on the country and study) express interest in using a new male method (Martin et al., 2000). A recent study of over 9,000 men in nine countries on four continents showed that more than 60% of men in Spain, Germany, Mexico and Brazil expressed willingness to use a new male contraceptive (Heinemann et al., 2005). These men would like to relieve their partners of some of the contraceptive burden in their relationship or would simply like a more reliable backup to condoms.

Men already use contraceptives.

Men have no readily available contraceptive between the condom, with its high typical-use pregnancy rate, and vasectomy, with its permanence. Still, using just these two methods, men already account for a third of total contraceptive use in the United States (Mosher et al., 2004 table 12). In great and increasing numbers, men are using the only two options they have. Adding in withdrawal, the numbers for male participation are even higher. Finally, with the huge increase in the use of condoms over the past two decades, at least regarding the United States, any statement that “men are not interested in contraception” is clearly out of date (Mosher et al., 2004 p. 1).

In countries with universal comprehensive health coverage, couples are less deterred by the up-front cost of permanent contraception, and vasectomy plays an even greater role than in the U.S. For example, in the Netherlands, 50% of couples 35 or older rely on sterilization for contraception, and of those sterilizations, almost 70% are vasectomies (de Bakker, 2004). In New Zealand, over half of men in their forties already have vasectomies (Sneyd et al., 2001).

Fathers’ rights movement and male contraception.

In addition to the emergence of a generation of men who want to contribute toward contraception in their relationship, a further cultural shift has taken place in the past decade. No longer is it just men “taking responsibility” that is the issue; men also want to take control of their own fertility.

It may sound heretical to imply that some seemingly accidental pregnancies may actually be planned by women. Yet for unmarried men in prosperous countries, this has become a common fear. In an environment of DNA paternity tests, computerized child support tracking, and more and more single women running out of time to have a baby, men have new reasons for wanting more perfect control over their fertility than is offered by condoms. These men are becoming more vocal, with whole websites dedicated to the cause (Garrison, 2005). A 2003 Men’s Health article explored this phenomenon and concluded that the time is right for new contraceptive options (Gifford, 2003).

Changing attitudes in the developing world.

For married men in poor countries, control over their fertility is essential from an economic standpoint (to stay out of poverty) and to avoid the up to 1-in-6 chance of losing their wives to death in childbirth (Save the Children, 2005). Cultural shifts and urbanization are also influencing desired family size.

In a 17-country analysis of data collected during the 1990s, men’s views on family size were closer to those of women than many in the family planning field once believed. Men aged 15-24 (who make up a quarter of men in many developing countries) wanted fewer children than men 25-34, who in turn wanted fewer than men in their 50s (United Nations Population Division, 2005; United Nations Population Fund, 2004).

However, in many countries, that desire is difficult to put into practice. Except for sterilization, no method is cheap enough to be financially viable for a large number of couples. The closest candidate is the IUD, which can have intolerable side effects for many women (see Limitations of Current Contraceptives for Women). A reversible long-acting male contraceptive would therefore fill a need not only for men who wish to control their fertility, but for many of their female partners as well — women who would not otherwise have access to acceptable, reliable contraceptives.

Some question whether men in developing countries would use male contraceptives. Indeed, attitudes vary from country to county, and no generalization can be made. Some countries have very individual histories with male contraception, such as India’s coercive vasectomy program in the 1970s, which turned Indian men away from vasectomy much the same way U.S. women are wary of IUDs (Cohen, 1996 p.11).

However, evidence indicates that though not all men may be interested, enough men are interested to provide a large market of early adopters. A survey of 4,000 men in locations as diverse as Edinburgh, Shanghai, Hong Kong and Cape Town showed that, though there were cultural differences in acceptability, even in the most conservative study center nearly half the men would use a new male hormonal contraceptive (Martin et al., 2000).

An even more recent and larger survey of 9,000 men in nine countries showed that, despite great country-to-country variation, in every country more than 57% of men would consider the idea (Heinemann et al., 2005). Not surprisingly, enthusiasm ran high in Germany and the United States, where condoms and vasectomy are already widely used. However, surprisingly to some, men were also very open to the idea in heavily Catholic Spain and Mexico — even more so than in France or Sweden . In the one Muslim country studied, Indonesia, men’s attitudes were very dependent on whether the new contraceptive would be approved by their religion. This shows the importance of working with religious authorities, as has been done by the highly successful family planning program in Iran, to identify passages in the Koran that support family planning as a positive contribution to personal and community health (Hoodfar, 1995, 2000).

Once the first men begin using a new method, change can be swift. Viagra’s meteoric rise has shown that societal changes can take place nearly overnight and that men’s reticence about talking about their sexuality is breaking down faster than ever.

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